Fracture Energy Signal (FES)

A proposed change to ICD-10-CM fracture coding

The problem

Every fracture in US claims data is recorded without the energy that caused it. A wrist fracture from a fall from standing height and one from a car crash carry the same code. As a result:

• There is no population baseline for how fractures occur by energy across the lifespan, in either sex.

• Every estimate of low-energy fractures relies on proxies: age cut-offs, fracture-site lists, or diagnosis codes that are often missing when the fracture is coded.

• The information already exists in the record, in the documented mechanism of injury and in EMS triage fields. It’s lost at coding.

The proposal

FES applies to every fracture code in the S-code range (Chapter 19): S02, S12, S22, S32, S42, S49, S52, S59, S62, S72, S79, S82, S89 and S92.

In each of them, the 7th character “A” (initial encounter, closed fracture) is retired and four new 7th-character values are added:

7th character value and Definition

A - Retired. Not valid for new claims. Historical “A” records map to energy unspecified.

New value - Initial encounter, closed fracture, low energy: at or below a fall from the patient’s own standing height (WHO), including no identifiable external force

New value - Initial encounter, closed fracture, intermediate energy: above standing height, below the high-energy threshold

New value - Initial encounter, closed fracture, high energy: at or above the American College of Surgeons field triage high-risk criteria

New value - Initial encounter, closed fracture, energy unspecified: energy can’t be determined from the record

Why “A” is retired rather than kept:

“A” is what every coder has used for every closed fracture since ICD-10-CM began. If it stayed valid, it would become the default catch-all code, and the energy data would be lost. Retiring it requires an energy value on every closed fracture. This is standard practice: when ICD-10-CM subdivides a code, the original becomes invalid for new claims.

How it works

• It uses the 7th character the fracture codes already carry. There’s no new code family.

• It covers every closed fracture S-code family, about 97% of all fractures, at any age and any point of entry into care.

• Coders take the value from the mechanism already documented. Energy is never inferred from age, fracture site or diagnosis.

• Historical “A” records map to “energy unspecified,” so long-term data series stay continuous.

• It travels on facility and professional claims alike.

Why it matters

FES captures the energy of the fracture at the one point it’s available. Nothing more, nothing less. It builds the first population record of the natural history of fractures across the lifespan, in both sexes, and gives every user of fracture data a defined, consistent energy value.

Comments

ASOP plans to submit both proposals to the ICD-10-CM Coordination and Maintenance Committee on November 25, 2026. Comments are welcome through November 15.

Bone Structural Integrity Signal (BSIS)

A proposed new ICD-10-CM code

The problem

Physicians who work directly on bone judge its quality every time they do: screw purchase, cortical thickness, how the bone takes fixation. That judgment drives the surgical course and implant selection, and then it disappears from the record. Claims data holds no record of the bone as physicians actually find it.

The proposal

BSIS is a single code that records a physician’s direct observation of poor bone quality, quantity or strength during a procedure.

Rules for use

1. It records the observation only. BSIS is assigned when the physician observes poor bone quality, quantity or strength, compared with normal bone, and documents it in the operative or procedure note. If it isn’t documented in that note, it isn’t coded.

2. It is limited to physicians working directly on bone. BSIS applies only when the physician is working directly on bone during the procedure and can observe its characteristics against normal.

3. It is independent of prior tests and diagnoses. BSIS reflects only what was observed during the procedure. It isn’t assigned or influenced by DXA or other test results, an existing osteoporosis diagnosis, or any other history.

How it works

• It’s binary. It’s coded when the observation is documented and not coded otherwise.

• It applies in any specialty, with or without a fracture.

• It reaches both facility and professional data. The physician reports it on the professional claim, and the facility coder assigns it from the same documentation.

• No new assessment is required. It records a judgment the physician already makes as part of the procedure.

• It stands on its own, independent of FES.

Why it matters

BSIS creates the first population record of bone as physicians directly observe it. It gives procedure and implant outcomes a bone-quality variable they’ve never had, and in procedures that don’t involve a fracture, it can identify compromised bone before a first fracture.

Comments

ASOP plans to submit both proposals to the ICD-10-CM Coordination and Maintenance Committee on November 25, 2026. Comments are welcome through November 15.